Jess: Hi, my name is Jess, and welcome to today’s webinar on tracking revenue for your practice. Conducting today’s webinar are Kathy Casbarro, the head of our SWAT team who has 30 years of experience in Practice Management, and Jason Barnes, our Chief Operating Officer who is responsible for the billing performance for 500 practices. Welcome, Jason and Kathy.

Jason: Hello, thank you for having us. And we’re really excited about this whole series of webinars that we get to put on. More importantly, Jess, is that we’re more excited about helping the entire chiropractic profession. When it comes to running a practice these days, we understand how many balls that a practice owner has to juggle. And for those of you on the phone today, we get to personally hear those stories.

Kathy, who I’ve worked with now for four years, and I get to interact with practice owners on a regular basis, talk to them about their frustrations, about their successes, the things that really drive them. And the fact that the mission that the entire chiropractic community shares for changing healthcare is really the main driver, makes the talk of money seem sometimes misplaced. But we know that without a solid financial backing, that mission will never be realized.

So, we want to start from that perspective today and really make sure that by talking about money, we can help achieve that dream, that mission, that we share with chiropractors.

And Jess, let’s get to the next slide here.

We wanna start out by helping practice owners understand what we’re trying to do. As an organization, we help practices in a number of different ways, scheduling, billing, documentation, and practice management. But today, we wanna focus on the revenue portion of that. We can’t break out just the billing without talking about your scheduling process, the intake process. When you’re talking about sealing revenue leaks, looking at the entire practice as a whole has to be part of the approach.

And Kathy and I, working together over the last few years, know that when you’re talking about office workflow or billing workflow, they’re really the same conversation most of the time. We separate them in this context to help people understand that when you’re looking at lower collections than what you’re expecting, that can be a frustration that can be scary because we know practices that can’t last for more than just a few months without writing that chip.

So, today, we wanna focus on understanding where in your process their breakdown occurred so that we can specifically identify it and then figure out a plan to solve it. But identifying it is without a doubt the first key.

So, knowing where you’re reimbursement gets stuck, as Kathy and I have worked together, Kathy, when you talk to practices, what’s the biggest frustration you get from practice owners when they’re not realizing the collections that they thought they would have?

Kathy: It’s when they’re not, you know, they can’t continue to treat their patients the way they want to, you know, being able to continue with their mission, so the frustration is that they need to bring in the money in order to continue that mission to help every patient that they have in their practice and, you know, that can be a problem for them.

Jason: Yeah. So, when that frustration happens, maybe their heart is not into treating the patients the way they wanted to because they’re worried about whether or not they can keep the doors open. We’ve actually had those conversations. I don’t wanna be overdramatic about it, Kathy, but it’s unfortunate. We’ve seen people forced to sell their practices and move backwards back to the role of associate while they figure out how to attack the problem again.

We wanna help people avoid that. We wanna see the chiropractic profession really explode, and I think we’re in a good position to help there. So, keep in mind, just kind of recap as I go through this, coming up with a process that’s repeatable for your office workflow, your intake process, is the only way that sealing your revenue approach that we came up with works. If you don’t have a set process, then there’s really difficulty in trying to diagnose it. But you have to make sure that you understand the connectors you’re looking at.

So, some of the examples that we’re talking about today is CPT codes. Am I in or out of network? Am I gonna get paid a certain amount? Do I know what that amount is supposed to be? We need to ask those questions and then be able to track the data across many months. And we deal with the smaller, you know, one chiropractor, part-time front office practices, and we got 10 locations, I’ve got 22 chiropractors, 6 physical therapists, I’ve got weight loss, and I need to make sure all of that is running together.

So, the difference between them is actually really, really small. Because the intake process, the data collection process that you have to follow is nearly identical. But now we have to track whether or not the breaking points are the same. And in our experience, they’ve been really, really similar.

So, Jess, can you hit the next one for us?

We know that you can’t operate and fix the problem at the same time. So, the amount of time that it takes you to come up with a root cause analysis of where your practice went wrong is critical. It’s critical to you enjoying a family life or work outside of your office.

Kathy, with some of the more complex problems, how much time does it take to actually figure out where the process is broken in a practice does it usually take?

Kathy: You know, Jason, in conversations we’ve had, we’re taking up a couple of weeks because there’s so much data that we need to go through to assess a practice. Having the right tools in place for ourselves and for the practice to analyze certain areas that we just need to focus on, it is always helpful in this.

Jason: Yeah. And so, we’re gonna ask Kathy to help us here in just a second because she is an expert at taking the data of practices and analyzing it and figuring out where it’s gone wrong. So, if there’s payment delay, if you’re a Blue Cross Blue Shield provider, a Medicare provider, what is the average turnaround time? And if yours is above or below average, why? If you’re sending claims out that are getting rejected 50% of the time, how do you know that? How do you address what to do differently on those claims to increase the percentage of acceptance by the insurance company and paying it? What is your practice doing to analyze that right now? Or are you simply letting your cards fall where they may? We wanna be able to attack that. So, you’ve got that potential to repeat errors if you’re not. So, we wanna make sure we reduce that or mitigate that to the lowest level that we possibly can. We know we’re in a fight with the insurance companies and especially chiropractic.

Any specialty, Kathy, and you know this better than anyone, any specialty that likes to see repeat business, like chiropractors do, is seeing the insurance company our biggest enemy. How on earth are we attacking the regularity and the repeat claims that are going out? How do we approach, making sure that those claims are as clean as possible?

Kathy: You know, Jason, you can talk about this now. This is critical to business today, and with the on-boarding everyone can take a deep breath with the on-boarding of ICD-10 changes coming and, you know, we have the Affordable Care Act in changing an insurance. Now is the most critical time to really put practices in place, to find out which insurance companies are gonna be slowing down in their payment, that are taking longer to process claims when we get over to ICD-10. It’s critical in that case.

So, you know, right now, the tools that we use really focus on payers and CPT codes and we focus on both the number of claims that are submitted out to payers and making sure that the expected allowed amount, whether they’re in or out of network, are being received by that practice.

So, what we’re really talking about is Billing Stats Report. It is a critical tool to use and to put in place for any practice right now so you can balance the payments that you are gonna receive from, you know, say [inaudible 00:09:31] today and in July and August when they start ramping up the ICD-10 and really focus on the one payer that’s not following the protocol to pay us in a timely manner.

Jason: Yeah. And billing stats was short for obviously billing statistics. And when we talk about billing statistics, what… Can you give us a few examples of the statistics that you look at most commonly with practices to make sure that they’re on the right track or at least their baseline is where you think it should be?

Kathy: Oh absolutely. I mean, it’s critical that we always look at the payers, you know, find out what the demographic is in their payer, which is the largest percentage, does the practice make 50% of their claims to Medicare, 50% of their claims to Blue Cross Blue Shield. So, first, we look at that, and then we start to measure their CPT code. So, how many 98940s are they sending out to a particular payer and what’s the reimbursement type? Is Medicare paying in 14 days and are they paying the correct allowed amount? So, the critical things that we look at are definitely payer and CPT and looking at when the claim was submitted and the payment back from the insurance company.

Jason: So, it’s pretty complex, I know, because I have done it thousands of times. Without a tool, without something that allows you to organize this data at a click, how long, I mean, what’s the time difference between doing it manually and having some sort of automation? Are there a lot of systems out there? I know it’s critical if somebody has the ability to do this, but what’s the time difference in organizing this information between automation and manually?

Kathy: I think, generally, from experience, I mean I have worked in practices that had 1 clinician, I’ve worked in practices that had up to 12 clinicians. Being a COO, I felt I had to analyze that data. If you just take one or two people practice owner and, you know, myself to figure it out. If it’s a team of six people, months it’s going to take you to run through reams of paper and running AR report to find out where the money is. By that time, it is sometimes too late to go back and get the money.

Jason: Too late, I think that’s the word we’re looking for. Sometimes, it’s too late. So, if somebody has a revenue problem right now, where they feel like they’re seeing the right amount of patients, and this is an experience that we have all the time. I’m just as busy as I’ve ever been, maybe even busier, but the money is not coming in, what is your advice to someone, Kathy? What’s the first step you’d take them on to diagnose this problem?

Kathy: So, the first thing we do is really getting through the patient life cycle, we go through how many patients they’re seeing, how many new patients they’re actually seeing. We wanna have goals that they set for themselves. Do they wanna see 12 new patients a month and they’re not getting there? Do they wanna have 200 other patient visits? You know, is that where we’re falling down. And then is the insurance change is that mixed change. So, we have to look at prior statistics and we have to make them relevant to today. So, we always go back 12 months and then take a look.

Jason: Gotcha. So, what I like about your answer, Kathy, and it always goes back to a workflow. We can’t ignore the fact that your plane has to stay in the air while you’re fixing the engines on it. So, if there’s a problem and you’re not looking at the process that you’re following, at the same time, you’re analyzing the data, you’re most likely gonna miss the fact that you have to make an immediate change. So, I really like that.

Jess, can you go to the next slide for us?

So, that process is so important to us, and here is a way that we’ve organized a process to look at, and so when a claim is created, this is looking at really a claim life cycle, not a patient life cycle like Kathy was just describing. But when you load a claim, what happens to it? In an automated system, like the one that we prescribe and we promote, and hopefully, you’re on a system like that, you’re gonna scrub that claim prior to it going out. You know, what if Medicare doesn’t pay for certain codes? You need to send them anyway, but you’re gonna have, you know, what are you gonna do with those charges when it comes back? Do you know how the system is supposed to behave? Are you gonna handle it manually? With new G-codes that are out there, with functional reporting, do you have the right charge amount? If you don’t, you’re just making it easier for the insurance companies to delay your payment by sending you back a rejection 30 days later or maybe longer, some of you may have just snickered, maybe longer, and letting them win at their own game.

So, we wanna make sure we open that claim up to a whole bunch of rules, we validate it, we submit it. And before it gets to the insurance company, we wanna make sure it passes all of those tests. So, having a process, and each one of those boxes represents a place where we can check to see that a claim is getting stuck. So, when you’re talking about sealing your revenue leaks, you have each one of those gaps to look at. So, in your own system right now, whatever system you’re using, if you don’t have checkpoints where you can look and see where things are getting stuck, diagnosing your problems can be very, very difficult.

So, if you’re having an intake problem, that means your claims are most likely gonna get stuck going out the door, which you’re gonna see missing information, missing referrals, missing authorization numbers that we wanna check on before it goes out the door. If it comes back rejected, you need to manage those denials.

Kathy, what is your approach with all of our billing teams right now when you see denials coming back in an alarming or above average rate for a payer or a practice?

Kathy: We look into really the root cause about it, you know. Is it actually a payer, is it a clearing house, we try to focus on, again, the root cause of where the problem is coming from. You know, the straight through processing that you’re demonstrating right here is specifically a claim life cycle. This has been so much help 15-20 years ago when [inaudible 00:16:30] and you know, there aren’t a lot of practice owners that are familiar with coding, and you know, I would have worked and have a system scrub my claim figure out ahead of time so I could, you know, add a modifier or look at the note before it went out to make sure that it was coding appropriately. So, yeah, root cause analysis is always the way to go for us to find out where the problem is.

Jason: So, there’s one thing I’ve got to add to that answer, Kathy, and something I get most excited about is, don’t do it alone. If you’re trying to manage a billing department on your own, our advice is, become part of some network. Well, we’ve got about 500 practices in ours. When a practice in Nebraska sees that Blue Cross Blue Shield made an adjustment to a policy or a way that they’re posting or some way that they’re managing rejections because of blue or black ink, whatever it is, we’ve learned that for that practice in Nebraska on Monday, and by Tuesday morning, we’ve applied the sticks to the other 499 practices across the country.

Kathy: Yeah. I have a real time example that’s huge, Jason, believe it or not, that first thing this morning, we received I’d say probably somewhere around 3,000 rejected claims from our clearing house, and if we didn’t have the technology that we have, we would have been able to jump all over those claims payable to that clearing house and find out what’s wrong and get it fixed, you know. It allowed us to do that in a very short period of time.

Jason: So, sealing the leaks of revenue in your practice, to recap, is first starting with a repeatable process, understanding where your gaps are, and then third is making sure you’re part of a network of people that are working together to beat the insurance companies. That’s one of the best ways that you’re going to have a chance at being successful, and we are big fans of a network. There is so much that we learn from our providers. We position ourselves as, hopefully, experts in the industry, but we know there is no one person in our group that knows it all.

Jess, could you go to the next slide, please?

So, here’s an example of one of the reports that we’re talking about. Now, there are 45 different parameters that we monitor and check, and anything, put any combination of those parameters together, there’s one example up there of a CPT code by insurance companies, and then following that is the diagnosis code where we can see which diagnosis codes are allowing which CPT codes to get paid by which payers. So, we can filter down to a single diagnosis code or a single CPT code or even just one payer if we want to, and then really take a deep dive into how they’re behaving over time or in a snapshot.

So, we wanna be able to help practices understand what’s happening. How does that help? If you’re treating patients, obviously you’re not gonna change the way you’re coding, you’re not gonna change the way that you’re choosing CPT codes, but when you have a choice that falls in the middle between two CPT codes or two diagnosis codes, you’ll know which ones are accepted by the insurance company based on the data. You’re not gonna be able to attend every webinar, you’re not gonna be able to listen to every coder’s advice, or pay for the consulting service that you need. But when you’re able to look at the data and you know which ones are getting paid and which ones aren’t, you’re then able to make very educated choices on how you’re going to proceed. Kathy, please chime in here. You might even be able to go back a little bit.

Kathy: You might be able to go back a little bit, yes.

Jason: So, you have to be able to organize the information that way. Otherwise, you’re going to leave money on the table. And leaving money on the table, we know, leads to treating less patients. We understand that you need to maximize your time.

There is that other aspect, Kathy, where if the balances aren’t right, you might be telling your patient that, “Oh, it’s more than they do.” And those patient relationships, we know, are the most valuable thing in your practice. The referrals that they make, the confidence that they have, not only on your ability to treat them, but your ability to set expectations and understand the financial arrangement that you’ve got, is critical to your success, and we take that very seriously.

Jess, can you go to the next slide, please?

So, the question is this, when do you take the deep dive? We are not recommending that you look at this report every day, weekly, or even monthly. Kathy mentioned earlier that you set goals and that we work with practices when those thresholds are being approached, either good or bad. And we wanna make sure there’s a trigger point. And in our organization, we use a visual trigger point. We set goals with our providers, and then when those providers are not reaching those goals, they’re able to see it in a picture right on the homepage. And they either can use this report themselves or work with us to take a deep dive into these reports and figure out why their collections are not where they want them to be, what is it about their workflow or their process that’s not working that needs to be tweaked or fixed.

Today, Kathy, real world example, we had a provider in California ask us this very question, and it turns out that one of the doctors in their office is on an average billing four months later than the dates of service. That will put a lag on anyone’s cash flow. And so, for the sake of anonymity, I’ll just call him Dr. Lewis. Dr. Lewis is going to have an important conversation today from a practice owner that’s gonna help them fix this moving forward. And that’s one of the things that your billing stats are gonna really show you when you know one of those thresholds is being met.

Jess, we always do this to you. We’re almost out of time. I believe there’s one more slide.

And so, here is the final kind of list to configure what are parameters that we have, and you can slice those up in any different way in our system and you can easily choose them and create the reports as you need, for instance, say, with that practice owner, we chose the rendering physician, the submission date of the claim, the status of the claim, and then finally, which payer it was, and we found out that there were certain payers that were waiting five months and not all of them. So, it’s really important for us with that practice this morning.

And Kathy, I know I didn’t see we’re out of time again. So, Jess, I’m gonna just turn it back to you to go over the take-home portion of this, then we can open up for any questions.

Jess: All right. Thank you, Jason. Just to let you guys know, if you are trying to receive the CEU for joining our webinar today, you are gonna receive a really short survey, I think it’s like two questions. Once you’ve filled out the survey, you’ll receive the certificate, so you can use that to get your credit for this webinar.

Jason: Thank you so much for attending today. It’s really our pleasure to talk about this. We’re passionate about practice success, and especially when it comes to our chiropractors and their mission to help the world change the way they look at healthcare. And so, we’re hoping that your practice, especially in this new year, is able to thrive and take off. And if there’s any other help that we can be, check out one of our blogs at genesischiropracticsoftware.com, and it’s a great way to reach out to us.

We’re proactive about the business of saving lives. We believe every person should be under Chiropractic care from their first breath until their last. Our proactive profession should use proactive technology like Genesis Chiropractic Software.